ZL3-26543-72638

4 vaccinations 9 coded responses 39 check-ins 8 free-text entries 6 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 378 / TN
Registered: 2021-01-02

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2020-12-29
Dose 1 — Moderna
2021-01-02
Registered in v-safe
2021-01-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness, Swelling · Chills, Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Chills, Headache

Adult check-in
2021-01-05
Health check-in — day 7, dose 1
Feeling: Good · Chills, Headache

Adult check-in
2021-01-19
Survey response — day 21, dose 1
MedDRA: Erythema, Medical counselling, Peripheral swelling, Pruritus, Skin warm — Feeling: Fair

Free text: severe injection site reaction @ 12 days after my injectionMy entire upper arm was extremely swollen, red, hot, & very itchyI called the(b)(6) County Health Department to inform them they advised me to call my PCH...

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-26
Dose 2 — Moderna
2021-01-26
Health check-in — day 0, dose 2
Feeling: Fair · Site: Redness · Fever · Headache, Fatigue or tiredness

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Swelling, Itching · None

Adult check-in
2021-02-02
Health check-in — day 7, dose 2
Feeling: Good · Site: Redness, Swelling · Headache, Fatigue or tiredness

Adult check-in
2021-02-09
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-16
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-23
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-02
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-09
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-27
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-27
Survey response — 6 months, dose 2
MedDRA: Influenza — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Flu B diagnosed on 7/20/2021

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-27
Report sent to call center — 6 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-08-05
Call successful
Participant prefers to complete VAERS report online
2021-10-29
Dose 3 — Moderna
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-03
Survey response — days 1–6 daily, dose 3
MedDRA: Adverse reaction — Feeling: Fair · Site: Redness, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Free text: I had an echocardiogram & stress test today, so that may have contributed to my symptoms

MedDRA releases: 2024-11 · check-in free text available
2021-11-04
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Redness, Swelling, Itching · Nausea

Adult check-in
2021-11-05
Survey response — day 7, dose 3
MedDRA: Unevaluable event — Feeling: Good · Site: Redness, Swelling, Itching · Headache

Free text: I received the flu vaccination today

MedDRA releases: 2024-11 · check-in free text available
2021-11-12
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-19
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-26
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-03
Survey response — day 35, dose 3
MedDRA: Bronchitis, Influenza virus test negative, SARS-CoV-2 test negative — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Bronchitis COVID, flu & strep test 12/2/2021 Negative for all

MedDRA releases: 2024-11 · check-in free text available
2021-12-03
Report sent to call center — day 35, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-06
Call 1 — Left Voicemail
2021-12-10
Survey response — day 42, dose 3
MedDRA: Bronchitis, Cough, Office visit — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Acute bronchitis- still coughing · Healthcare visit (other): Primary Care doctor, also

MedDRA releases: 2024-11 · check-in free text available
2021-12-10
Report sent to call center — day 42, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-14
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-12-14
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-01-28
Survey response — 3 months, dose 3
MedDRA: Bronchitis, Dizziness, Exposure to SARS-CoV-2, Headache, Nausea, SARS-CoV-2 test — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Bronchitis in December Now nausea, dizziness, headaches I've been exposed to covid & tested on 1/27/2022 I'm waiting on the results of the send off test

MedDRA releases: 2024-11 · check-in free text available
2022-01-28
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-02-01
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-12
Dose 4 — Moderna
2022-05-01
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-05-19
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-24
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-12
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-11
Survey response — 6 months, dose 4
MedDRA: Diverticulitis, Diverticulum, Gastrointestinal bacterial overgrowth, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Bacterial overgrowth ( Stomach) Diverticulitis & diverticulosis · Healthcare visit (other): Several Outpatient tests

MedDRA releases: 2024-11 · check-in free text available
2022-10-11
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-10-12
Call successful
Does not wish to fill out VAERS report
2023-04-12
Survey response — 12 months, dose 4
MedDRA: COVID-19, Gastrointestinal bacterial overgrowth, Unevaluable event, Urinary tract infection — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-04-12
Report sent to call center — 12 months, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-04-13
Call 1 — Requested Callback
2023-04-14
Call 2 — Left Voicemail
2023-04-14
Callback requested for

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-29	Moderna
2	2021-01-26	Moderna
3	2021-10-29	Moderna	No
4	2022-04-12	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-07-27	Successful 2021-08-05	Participant prefers to complete VAERS report online
2021-12-03	Successful 2021-12-14	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-12-10	Successful 2021-12-14	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-01-28	Successful 2022-02-01	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-10-11	Successful 2022-10-12	Does not wish to fill out VAERS report
2023-04-12	Unsuccessful

Free text

Release 2 — day 21, dose 1

2021-01-19

Symptoms: severe injection site reaction @ 12 days after my injectionMy entire upper arm was extremely swollen, red, hot, & very itchyI called the(b)(6) County Health Department to inform them they advised me to call my PCH...

redacted (b)(6)

Release 9 — 6 months, dose 2

2021-07-27

Symptoms: Flu B diagnosed on 7/20/2021

Release 10 — days 1–6 daily, dose 3

2021-11-03

Systemic reaction (other): I had an echocardiogram & stress test today, so that may have contributed to my symptoms

Release 10 — day 7, dose 3

2021-11-05

Systemic reaction (other): I received the flu vaccination today

Release 10 — day 35, dose 3

2021-12-03

Symptoms: Bronchitis COVID, flu & strep test 12/2/2021 Negative for all

Release 10 — day 42, dose 3

2021-12-10

Symptoms: Acute bronchitis- still coughing

Healthcare visit (other): Primary Care doctor, also

Release 11 — 3 months, dose 3

2022-01-28

Symptoms: Bronchitis in December Now nausea, dizziness, headaches I've been exposed to covid & tested on 1/27/2022 I'm waiting on the results of the send off test

Release 12 — 6 months, dose 4

2022-10-11

Symptoms: Bacterial overgrowth ( Stomach) Diverticulitis & diverticulosis

Healthcare visit (other): Several Outpatient tests

Each entry is dated by the survey it was written in (the CDC re-sent the releases with survey dates in 2025); click a date to see that survey response. The CDC cut some text off at about 250 characters: symptoms in every release, and the other two fields in releases 9-12. Those entries are marked "cut off by CDC".

MedDRA terms by release

Field	Preferred term	2021-09	2023-04	2024-11
HCVO	Office visit	·	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Bronchitis	·	·	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Diverticulitis	·	·	✓
SD	Diverticulum	·	·	✓
SD	Dizziness	·	·	✓
SD	Erythema	✓	✓	✓
SD	Exposure to SARS-CoV-2	·	·	✓
SD	Gastrointestinal bacterial overgrowth	·	·	✓
SD	Headache	·	·	✓
SD	Influenza	✓	·	✓
SD	Influenza virus test negative	·	·	✓
SD	Medical counselling	✓	✓	✓
SD	Nausea	·	·	✓
SD	Peripheral swelling	✓	✓	✓
SD	Pruritus	✓	✓	✓
SD	SARS-CoV-2 test	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Skin warm	✓	✓	✓
SD	Urinary tract infection	·	·	✓
SRO	Adverse reaction	·	·	✓
SRO	Unevaluable event	·	·	✓

✓ active code · ○ coded but marked inactive · blank = not in that release